Two weeks ago, President Donald Trump signed an executive order reiterating his intent to repeal the Affordable Care Act and allowing the Department of Health and Human Services to not enforce regulations under the ACA“[t]o the maximum extent permitted by law.” This immediate attack on the ACA was expected but shocking, especially to those who cannot afford health care without it.
Since the ACA requires qualified health plans to cover birth control, pregnancy care and cancer or STD screenings, among other things, many women (and anyone else who can get pregnant) covered under the ACA are worried about the possibility of repeal. Under the ACA, states were supposed to extend Medicaid to everyone with incomes up to 133 percent of the poverty level.
But after the Supreme Court ruled states did not have to expand Medicaid, Wisconsin chose not to do so. Instead, Gov. Scott Walker restructured the program to make it available to everyone up to 100 percent of poverty level. Walker’s decision gave a lot of people Medicaid, but took it away from many people eligible under the previous version, including parents with dependent children who have an income of up to 200 percent of the poverty level. There are a lot of parents with dependent children who lost coverage.
Wisconsin does not actually have a “coverage gap” — where there are people ineligible for both Medicaid and subsidies under the ACA — but even with subsidies, it can be hard for these parents to afford insurance. If they lose ACA subsidies, health care becomes impossible to afford. This could prove especially devastating for single mothers, who are paid less on average than their male counterparts but still have to afford child care and health care.
The Wisconsin Well Woman Program, which provides screenings for breast cancer and cervical cancer, and some other tests for common health concerns and diseases such as multiple sclerosis, is still operational. But this program is only for women ages 45 to 64 with incomes up to 250 percent of the poverty level. Since the ACA provides coverage for preventive care, without it many women outside this age range will not be able to afford these screenings.
The Centers for Disease Control and Prevention recommend Pap tests for women aged 21 to 65, and mammograms for ages 50 to 74, or sometimes as early as 40 depending on risk factors. Both of these ranges fall partly outside the ages covered by the Well Woman Program.
In addition, this program has been cut back in anticipation of women getting coverage for these services through the ACA instead, even after an outcry over lack of data and increased difficulty in getting care. Without the ACA, the Wisconsin Well Women Program becomes inadequate to provide these services.
The ACA also provides protection for transgender people by prohibiting insurance companies from discriminating based on gender identity or transgender status if they receive federal funding or have plans on an insurance marketplace. This ensures that transgender people cannot be refused coverage, have their coverage cancelled or pay higher premiums simply for being transgender anymore. Transgender women already face discrimination and high rates of poverty, and repealing the ACA could deny them access to cancer screenings, birth control, transgender-specific health care or simply all coverage.
Transgender men and nonbinary people would also face loss of coverage, and lack of coverage for birth control, screenings and pregnancy care would affect many people. Policies to deny access to birth control and pregnancy care are clearly intended to target women, but women are not the only ones affected. A repeal of the ACA would also have staggering implications for people with disabilities. Without subsidized insurance, they could lose the ability to afford lifesaving medications, treatments and procedures.
In short, people could very well lose their lives as a direct result of repealing the ACA. Many people can’t afford to change jobs now in anticipation of losing coverage. This unfortunately furthers the ability of employers to exploit them, legally or not, because they cannot leave, and disabled women are especially vulnerable. For all women, and Wisconsin women specifically, a repeal of the ACA could mean losing access to birth control, not receiving proper prenatal care and even being denied coverage due to pregnancy.
Many conservatives paint birth control as a luxury, but it is absolutely vital to ensuring that anyone who can get pregnant has the same level of freedom and personal autonomy as people who can’t. In addition, many women need birth control to manage hormones, whether they’re cisgender, transgender, intersex and/or nonbinary. Birth control is a medical necessity.
In another attack on reproductive rights, bill H.R.7 would prevent plans qualified under the ACA from covering abortion. This means anyone with a plan that covered abortion services could not receive subsidies, effectively making abortion inaccessible to low-income pregnant people.
It also means insurance companies will have to eliminate abortion coverage or lose their qualification, which would have widespread effects. Given these attempted restrictions on reproductive rights and reproductive care, it seems there wouldn’t be many options left for sexually active people who can become pregnant.
Want to avoid pregnancy? No coverage. Want to end a pregnancy? No coverage. Want to give birth? No coverage. Want to raise a healthy child? No coverage.
The clear message here is that the lives and bodies of low-income people are not their own. Since I sincerely doubt the conservative men spearheading these attacks are transgender-inclusive, this message is intended for women. These measures are an attempt to make all women into poor baby machines dependent on men for support, and leave already poor women out in the cold entirely, with no way to provide basic health care for themselves or their children.
The fact that a repeal targets women and children makes the Republican agenda transparent. Repealing the ACA is not about affordability or efficiency, it’s about ensuring that life itself is an expensive luxury only available to those whose lives and labor are valued by richer people.